Individual
DR. YAZAN A ABDALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10012 KENNERLY RD, SUITE 404, SAINT LOUIS, MO 63128-2197
(314) 543-5911
(314) 543-5914
Mailing address
10012 KENNERLY RD, STE 404, SAINT LOUIS, MO 63128-2197
(314) 543-5911
(314) 543-5914
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2007016056
MO
207RG0100X
Gastroenterology Physician
Primary
2011014220
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
156440048
MEDICARE PTAN #
MO
Enumeration date
08/18/2008
Last updated
03/14/2017
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